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MEMBER EVENTS COMMUNITY FUN Community is always planning great events, big and small, for our Members in the Houston and Beaumont areas! Do you have an event suggestion? Email it to CommunityAffairs@CommunityHealthChoice.org. ASTROS VS. DETROIT TIGERS ON JULY 15 Members walked the bases after the game! COMMUNITY CARES FESTIVAL IN KATY ON SEPTEMBER 8 We’re bringing Member events to our communities! Here are pictures from our Community Cares Festival in Katy. Watch our Member Events Calendar for more community events. CommunityHealthChoice.org > Member Resources > Medicaid/CHIP > Member Events. WATER SAFETY CLASS Community and the YMCA of Greater of Houston want families to be safe around water. Community Members at some Houston-area apartment complexes learned how to “Jump, Push, Turn, Grab” and “Swim, Float, Swim.” Children can use these skills if they accidentally fall in the water. 2
MEMBER EVENTS COMING SOON! HOLIDAY EVENTS OUR HOLIDAY EVENTS ARE AROUND THE CORNER. Watch your mail and e-mail for the invitation. Children’s Museum of Houston on November 30. Children’s Museum of Beaumont on December 7. COMMUNITY COMMUNITY’S ANNUAL NOTICE PLEASE READ IMPORTANT INFORMATION ABOUT YOUR BENEFITS POR FAVOR LEA LA INFORMACIÓN IMPORTANTE SOBRE SUS BENEFICIOS THINGS YOU NEED TO KNOW Please read important information about your benefits and being our Member. Go to CommunityHealthChoice.org > Member Resources > Annual Notices. 3
MEMBER ADVISORY GROUP COMMUNITY LISTENS Did you know that Community Health Choice has a Member Advisory Group? It is called Community Listens. We want to know what you think. We want to share what Community is doing. At our meetings, Members share their thoughts about the services we provide. We are grateful for their input because it helps us serve you better. Members who attend a Community Listens meeting also get a sneak peek of upcoming Member events. Our latest Community Listens meeting was on August 23 in Beaumont at our Community Cares Center. If you would like to be a Community Advisor, please email Claudia.Garcia@CommunityHealthChoice.org. MEMBER SERVICES MEMBER HANDBOOK SPOTLIGHT STAR Do I have access to out-of-network services? We provide Members with out-of-network services that are medically necessary and covered benefits that are not available in our network. If those services become available, Members will need to go to one of our network Providers. Prior authorization is required, except for emergency situations. What if I get sick when I am out of town or traveling? If you need medical care when traveling, call us toll-free at 1.888.760.2600 and we will help you find a doctor. If you need emergency services while traveling, go to a nearby hospital, then call us toll-free at 1.888.760.2600. What if I am out of the state? If you need emergency services while traveling, go to a nearby hospital. What if I am out of the country? Medical services performed out of the country are not covered by Medicaid. CHIP AND CHIP NEWBORN What if I get sick when I am out of town or traveling/what if my child gets sick when he or she is out of town or traveling? If you/your child needs medical care when traveling, call us toll-free at 1.888.760.2600 and we will help you find a doctor. If you/your child needs emergency services while travelling, go to a nearby hospital, then call us toll-free at 1.888.760.2600. 4
MEMBER SERVICES – MEMBER HANDBOOK SPOTLIGHT What if I am/my child is out of the state? If you/your child needs medical care when out of state, call us at 713.295.2294 or toll-free at 1.888.760.2600, and we will help you find a doctor. If you/your child needs emergency services when out of state, go to a nearby hospital, then call us at 713.295.2294 or toll-free at 1.888.760.2600. You/your child will need to return to our service area for follow-up care when well enough. We cover care for true emergencies anywhere you/your child go inside the United States. You do not need to call your/your child’s Perinatal Provider or Primary Care Provider before getting emergency care, but do call your/your child’s Perinatal Provider or Primary Care Provider and our Member Services within 24 hours of the emergency, or as soon as possible. What if I am/my child is out of the country? Medical services performed out of the country are not covered by CHIP. CHIP PERINATE What if I get sick when I am out of town or traveling? What if my child gets sick when he or she is out of town or traveling? If you/your child needs medical care when out of town or out of state, call us at 713.295.2294 or toll-free at 1.888.760.2600, and we will help you find a doctor. If you/your child needs emergency services when out of town or out of state, go to a nearby hospital, then call us at 713.295.2294 or toll-free at 1.888.760.2600. You/your child will need to return to our service area for follow-up care when well enough. We cover care for true emergencies anywhere you/your child go inside the United States. You do not need to call your/your child’s Perinatal Provider or Primary Care Provider before getting emergency care, but do call your/your child’s Perinatal Provider or Primary Care Provider and our Member Services within 24 hours of the emergency, or as soon as possible. What if I am/my child is out of the country? Medical services performed out of the country are not covered by CHIP. *Read your handbook at CommunityHealthChoice.org > Plans and Benefits. You may also ask for a copy through your My Member Account. COMMUNITY'S VALUE ADDED SERVICES Community’s Value Added Services are effective from September 1, 2018 – August 31, 2019. We are happy to offer these extra services to you. Limitations may apply. If you have any questions, call Member Services toll-free at 1.888.760.2600. STAR 24-Hour Nurse Hotline Nurse Advice Line for all Members 24 hours per day to help Members decide where to go to get the care needed. The nurses also provide health education, nurse-initiated follow-up, and network referrals. Transportation Services Extra help with getting a ride to a doctor’s visit when state services are not available Extra Vision Services Members receive a $100 allowance towards upgraded frames, lenses, and lens options or contact lenses every two years. The benefit period is measured from the date of service. When contact lenses are chosen, the allowance is 5
MEMBER SERVICES – VALUE ADDED SERVICES applied to the participating provider’s retail cost for the contact lenses and professional services specific to contact lens wear, e.g., fitting, assessment and follow-up. Members who elect to upgrade their eyewear purchase with a retail value greater than the $100 allowance are financially responsible for paying the participating provider’s usual and customary (retail) cost of the difference between the cost of the eyewear selected and the $100 allowance. Sports and School Physicals One each year for Members age 4 through 19 Disease Management Educational materials for Members who are enrolled in our Asthma and Diabetes Care Management Programs Help for Members with Asthma Asthma educational materials and one allergy-free pillowcase each year to Members enrolled in our Asthma Care Management Program. Member gets one pillowcase per year based on when Member received one before. Extra Help for Pregnant Women $25 gift card for completing a prenatal checkup within 42 days of enrollment. $25 gift card for completing a postpartum checkup within 21-56 days after giving birth Health and Wellness Services Up to $100 allowance toward an annual Baker Ripley membership in the Harris Service Area Healthy Play and Exercise Programs $30 gift card each year for school-aged Member up to grade 12 who are in a school-sponsored extracurricular sports (athletic) program to pay for program fees, supplies or uniforms Healthy Play and Exercise Programs $40 gift card each year for Members up to grade 12 who participate in a youth sports league (apart from extracurricular, school sponsored activities) Gift Card Program $10 gift card for each of up to six well-child checkups before turning 15 months old, plus a $25 bonus gift card for completing all six checkups, for a total of up to $85 Extra Dental Services for Adults (age 21 and older) and Pregnant Women Two routine dental exams per year with teeth cleaning, x-rays, fillings, non-surgical extractions, and emergency exams (limited) CHIP 24-Hour Advice Hotline Nurse Help Line for all Members 24 hours per day to help Members decide where to go to get the care needed. The nurses also provide health education, nurse-initiated follow-up, and network referrals. Extra Vision Services Members receive a $100 allowance each year toward the choice of: (1) upgrades for frames, lenses, and lens options or (2) contact lenses. The benefit period is measured from the date of service. When contact lenses are chosen, the allowance is applied to the participating provider’s retail cost for the contact lenses and professional services specific to contact lens wear, e.g., fitting, assessment, and follow-up. Members who elect to upgrade their eyewear purchase with a retail value greater than the $100 allowance are financially responsible for paying the participating provider’s usual and customary (retail) cost of the difference between the cost of the eyewear selected and the $100 allowance. 6
MEMBER SERVICES – VALUE ADDED SERVICES Transportation Services Extra help with getting a ride to a doctor’s visit when state services are not available Sports and School Physicals One each year for Members age 4 through 19 Disease Management Educational materials for Members who are enrolled in our Asthma and Diabetes Care Management Programs Help for Members with Asthma Asthma educational materials and one allergy-free pillowcase each year to Members enrolled in our Asthma Care Management Program. Member gets one pillowcase per year based on when Member received one before Health and Wellness Services Up to $100 allowance towards an annual Baker Ripley membership in the Harris Service Area Healthy Play and Exercise Programs $30 gift card each year for school-aged Member up to grade 12 who are in a school-sponsored extracurricular sports Healthy Play and Exercise Programs $40 gift card each year for Members up to grade 12 who participate in a youth sports league (apart from extracurricular, school sponsored activities) CHIP PERINATAL NEWBORN 24-Hour Advice Hotline Nurse Help Line for all Members 24 hours per day to help Members decide where to go to get the care needed. The nurses also provide health education, nurse-initiated follow-up, and network referrals. Transportation Services Extra help with getting a ride to a doctor’s visit when state services are not available Disease Management Educational materials for Members who are enrolled in our Asthma and Diabetes Care Management Programs CHIP PERINATAL UNBORN 24-Hour Advice Hotline Nurse Help Line for all Members 24 hours per day to help Members decide where to go to get the care needed. The nurses also provide health education, nurse-initiated follow-up, and network referrals. Transportation Services Extra help with getting a ride to a doctor’s visit when state services are not available Disease Management Educational materials for Members who are enrolled in our Asthma and Diabetes Care Management Programs Health and Wellness Services Up to $100 allowance toward an annual Baker Ripley membership in the Harris Service Area 7
CARE MANAGEMENT WHERE SHOULD YOU GO FOR MEDICAL CARE? PRIMARY CARE DOCTOR URGENT CARE CENTER EMERGENCY ROOM GO FOR MOST OF YOUR MEDICAL NEEDS GETS TO KNOW YOUR HEALTH NEEDS TO KEEP YOU WELL TREATS CERTAIN HEALTH ISSUES RIGHT AWAY TO KEEP FROM GETTING WORSE SAVES LIFE AND LIMB GO ONLY IN AN EMERGENCY SOME REASONS TO VISIT Common illnesses like cough, fever, and sore throat Annual wellness checkup Lingering health problem that has lasted more than two weeks Routine visits for ongoing illnesses like diabetes SOME REASONS TO VISIT Stitches Broken bones Flu or sinus infection SOME REASONS TO VISIT Heart attack Stroke Severe head or eye injuries Wound that will not stop bleeding WAIT TIME WAIT TIME Short-to-medium WAIT TIME Short Schedule an appointment but may be seen same day HIGH COST MODERATE COST LOW COST Usually do not need an appointment Expect a long wait unless the hospital staff determines it is an emergency 8
WELLNESS CORNER COMMUNITY REWARDS FOR MOM & BABY FOR STAR MEMBERS Community has launched a new Community Rewards program for Mom & Baby! In this program, Members get rewarded for healthy activities! FOR MOM: • A $25 gift card for early prenatal visit within 6 weeks of becoming effective • A $25 gift card for timely postpartum visit 3 to 8 weeks after delivery FOR BABY: • Up to $60 for timely well-child checkups (a $10 gift card for each of 6 checkups completed before 15 months of age) • A $25 bonus gift card if all 6 checkups are completed in time WHO IS THIS FOR? This program is for moms and babies in our STAR program. New moms with pregnancy Medicaid and newborn STAR babies are eligible. HOW DO I GET STARTED? You will get a phone call to help you sign up. So make sure we have your correct phone number so we can call you. You can also activate online through your My Member Account. HOW DO I GET REWARDED? You get rewarded when you tell us that you have completed your activities. The easiest way to tell us is through your My Member Account. If you don’t have a My Member Account, set one up today at CommunityHealthChoice.org > Member Login. Or you can wait for our phone call. For more information, please call our Member Services department toll-free at 1.888.760.2600. 9
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